Getting Back from Burnout

I've always fancied myself as a futurist, but falling apart 3 years ahead of a pandemic was something even I would never have predicted.

In mid-2017 I was working as a GP in a busy walk-in centre, serving the needs of my list of patients as well as the unexpected issues that naturally arise in any seaside town. I was a board member of the local commissioning group, able to participate in the decisions made to transform care for the better. I was even the innovation lead, tasked with taking new technology into the NHS.

As a geek who went to medical school to find a way of using technology to treat people, you'd have thought I'd have been pretty happy. I certainly thought I should have been.

I wasn't.

I was miserable at work. I felt like I was drowning in the endless flow of patients through my door. I started to sleep less, worrying about my patients long after I’d left the surgery. I woke early, exhausted and dreading the day to come.

I had heard of the Practitioner Health programme, which supports doctors and other healthcare workers with mental health issues, and scheduled a visit early in 2017. After a call and a visit, I convinced myself that things weren’t that bad and I just needed to hit my meditation app a little more often.

The illusion that you need to do more is common in burnout, even in the face of the facts. Nothing seemed to change despite my best efforts. I felt like the pilot of a hot air balloon that is losing height and heading towards the ocean. In an effort to keep airborne I was throwing things out of the basket, hoping that I’d have enough lift in the balloon to keep me airborne. Convinced that work was the most important thing, I started to throw the “non-essential” ballast out. I gave up seeing friends, exercise, and my past times, to work even harder. Surely that was the solution, right?

Then, one scorching hot day in June 2017, my empty balloon crashed down. I couldn't do it anymore.

Seemingly all at once, I was unable to work. I tearfully phoned in sick, thinking that a week or so away from the coalface would help see me right. In the end, I spent the following 5 months at home, slowly recovering with the help of my wonderful wife, family, friends, my GP, and the PHP. I gradually returned to work, but realised that things had to change, and I had to pursue the career I really wanted. By making the change, taking time to care for myself and be with others, and to remember to talk when I felt bad, I've continued to recover and stand here 3 years later as part of a brilliant team transforming healthcare around the world. I’m afloat again, and it feels wonderful, but memories of that trip through a personal hell has given me a passion to help others avoid their own crash landing.

What is burnout?

While burn-out has been around for a long time, a good definition has been surprisingly hard to come by. It has a medical definition, but a useful one I like to share is that “Burnout is a state of physical, emotional, and mental exhaustion caused by long term involvement in demanding situations”¹.

From this side of the crash, it’s obvious that I was burnt out. I was physically exhausted in the months leading up to my time off, yet couldn’t sleep. I was jittery and numb, unable to form the connections with patients I had so enjoyed before. All of my thoughts circled around work, leaving no time for the most important things in life - my wife, family and friends.

As is common with work-related stress, I had symptoms of anxiety - a constant fearfulness and worry that would attach to almost anything that reared its head. As my burnout worsened this was matched with depression. For me this was a loss of hope and happiness, constant tearfulness and a certainty that I was never going to return to work again. Having treated patients with all these conditions for nearly 20 years, I still had no idea just how awful it was possible to feel.

And then, of course, we have COVID-19. For healthcare workers this has increased workplace stress, as well as heaping the grim reality of a pandemic and the restrictions on our way of lives. Some of us are working from home, and as a result are isolated from colleagues. Others have been furloughed and face financial and personal hardship, which may have made matters worse. As winter closes in and a second UK lockdown bites, many of us will be suffering more than ever before.

So, what can you do? If you're reading this and starting to wonder about whether you might be burnt-out, there is a fair chance that you would benefit from doing something about it.

First and foremost, hear this message: It is okay not to be okay. You are not alone, and you can recover.

The next step is one of the hardest - speaking about it. Men are famously poor at talking about their feelings, and even worse at admitting that they aren't coping. Do not doubt just how brave it is to admit you aren't managing. Not only is it the first step to recovery, but it marks the first punch you will land on your enemy which has convinced you that you are alone.

You’re going to have to reach out for help. This could be your friends, family, or people at work. You may be certain that you are alone, or that you cannot or should not seek help. Again, you are being lied to by yourself. If you don’t feel comfortable speaking to someone you know, call your GP, or even services such as the marvellous Samaritans (116 123), or check out Mind.

Every person affected by burnout, or anxiety, or depression, or any combination of the multitude of mental health issues that are so common yet quietly carried, will have their own personal story and way forward. It’s beyond this short blog post to cover it all, but common to everything is being able to say that you are struggling. Culture and society might have taught you that strength is stoically bearing the burdens that are placed on you, and that showing weakness is to be avoided at all costs. I’m here today because I took a crash course in the fact that the opposite is true, and that the way to recover is to ask for help. Whether it is your work that is burning you out, or the pandemic hemming you in, you are very much a human being who deserves help from time to time. You would do this for someone else, so all you have to do is let someone else do it for you.

References

1. Clare Gerada: Understanding burnout. BMJ 2020;369:m1595